Evaluation of four mesh fixation methods in an experimental model of ventral hernia repair.

BACKGROUND: The present animal study was conducted to comparably investigate the performance of four different fixation techniques of intraperitoneally implanted meshes.

MATERIALS AND METHODS: Fifteen New Zealand white rabbits were used. In each animal, four abdominal wall defects were created and repaired with four pieces of intraperitoneal mesh (Parietex Composite), fixed with nonabsorbable (titanium) spiral tacks (group A), absorbable (lactic and glycolic acid co-polymer) screw-type tacks (group B), transfascial polypropylene sutures (group C), or fibrin glue (group D). Adhesion formation, mesh shrinkage, tensile strength, and host tissue response were evaluated at 90 d.

RESULTS: Adhesions were observed in all groups, and differences were not significant. The percentage of shrinkage was higher in group C (26.91%), lower in group D (12%), whereas in groups A and B, the mean shrinkage was 20.17% and 23.33%, respectively (P = 0.032). The incorporation of mesh fixation element to the abdominal wall was 9.18 ± 3.91 N, 6.96 ± 3.0 N, 13.68 ± 5.38 N, and 2.57 ± 1.29 N, in groups A, B, C, and D, respectively (P < 0.001). Regarding local inflammatory response and foreign body reaction, no difference was observed between groups. However, with respect to fibrous tissue presence, its quantity was clearly less in group D compared with the other groups (P < 0.001).

CONCLUSIONS: None of the examined fixation techniques proved to be ideal. Probably, the best way to fixate an intraperitoneally implanted mesh may be achieved using a combination of the studied materials. Prospective randomized trials are needed to confirm the superiority of the combined use of different fixation devices in clinical practice.